Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2827 | MA |
NPI | 1013383751 |
---|---|
Provider Name | Jessica Poeira |
First Address | Wareham, MA 02571-2174 |
Second Address | Wareham, MA 02571-2174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |